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Month: January 2015

As a child I never really had a hero. I’m reminded I should have had one, or at least that other people did, when I have to fill in “secret questions” for password recovery: alongside “mother’s maiden name” and “place of birth” you sometimes see “childhood hero”. I never had one.

Now I’m interested in implementation science and K* and I wonder: should I have a hero now? Or more broadly: who are the heroes of knowledge mobilisation?

There are lots of heroes in the world: footballers, actors, musicians. Some heroes are super: Superman, Silk Spectre, Jean Grey. And some heroes are real, and professional: in public health, Edward Jenner is known for pioneering the development of the smallpox vaccine, John Snow is famed for “removing the pump handle” as part of his investigations into the causes of cholera, and Louis Pasteur recognised for his work on vaccination and pasteurization.

Except… that if you read Bruno Latour’s book The Pasteurization of France (originally published as Les Microbes: guerre et paix) you find presented a different perspective on Pasteur’s work and legacy. Once you’ve read that it’s a lot harder to regard other heroes in quite the same way as you once did.

Alongside the apparently heroic scientific work of Pasteur, work which has led to his lasting fame and celebrity within France and elsewhere, Latour sets all the other work that was necessary for Pasteur’s activities to change the way people thought and acted. Some of this work was conducted by Pasteur himself and will be familiar to anyone working in knowledge mobilisation: the work of reasoning and convincing and persuading and enrolling and so on. He played an important part in enrolling the various “actors” (that is, the individuals and groups and organisations) necessary to the success of his work (and there is an interesting sociological understanding by which we may think not only of the people involved in this but in the non-human actors too: Michel Callon’s (1986) account of the role played by scallops in debates over the scientific and economic debates about conservation and fishing in St Brieuc Bay in Brittany is exemplary).

There is no issue, then, that what Pasteur did was anything less than very important and scientifically remarkable. But much of it was conducted by others who worked for or around or simply at the same time as Pasteur, who supported Pasteur for reasons that range from the altruistic to the self-interested, the pragmatic to the political, and who were medical practitioners or farmers or local politicians or industrialists or rival scientists or something else entirely.

In short: we talk of Pasteur’s work and of pasteurization but in doing so we focus only on the activities of the person apparently at the centre and neglect all the work that went on around them, work that not only supported and publicized Pasteur’s activities but in many ways enabled and constructed it.

Latour describes the complexity of what occurred and the importance of the network of alliances that led to the production of scientific results and the construction of what is science. In Art Worlds (1982) Howie Becker proposed that the answer to the question “what is art?” is to be found among the individuals and groups that collectively define, through their discourse and their actions, what is and what is not art. Latour here addresses how the question “what is science?”, or perhaps “what comes to be regarded as scientific?” can be answered; the answer lies among all the individuals and groups that have an interest (or can be made to be interested) in the scientificity of a given claim or set of claims or proposed action.

And in emphasizing the absence of a boundary between science and society Latour addresses the claims of (some) scientists that those engaged in social studies of science don’t really understand science. His response seems to be that those who argue this don’t really understand society and that insisting on science as an undertaking of pure reason neglects the important of force (or power) in the making of any claim to truth or the realisation of any change. Latour’s concern is thus not simply with Pasteur’s scientific achievement but, perhaps, with how the science came to be regarded as an achievement (a process which took many years) and how the achievement, constructed in this way, ultimately led to practical changes in human health in France and worldwide. If we regard Pasteur as a hero then we might also consider how he came to be regarded in that way and what was necessary for the establishment of that regard.

So are there heroes in K* and implementation science? Sure, if you want there to be: go ahead and pick some. But for my money the always-already collaborative and systems-based nature of implementation means that there thinking of individual heroes means ignoring the complex ways in which change really occurs and knowledge mobilisation actually takes place.

There were three noteworthy English victories over France in the Hundred Years War. The best-known is the final one, the Battle of Agincourt (1415), but the earlier battles are just as historically and strategically interesting.

The second of these was the Battle of Poitiers (1356) in which a combined English and Gascon army led by Edward, Prince of Wales (later known as the Black Prince) defeated a much larger French force. The French had a number of apparent advantages: they were on home territory, they had many more men (probably around 16000, twice the size of Edward’s force of around 8000), and they were eager to drive the English out of France because English forces had been at large for years and had pillaged and killed widely. Yet the French lost, and lost badly: their King, Jean II, was taken prisoner and the Oriflamme, the sacred French battle standard, was captured. The defeat was met with surprise across France and Europe and marked a turning point in the status and authority of the French nobility.

Historians have proposed a number of reasons for this unexpected loss. I think that our current understandings of implementation can be used to understand some of the failures of the French army. I suggest three implementation issues were involved and in relation to each we can see how Edward’s forces were successful in making beneficial changes that the French army failed to enact.

First, English longbowmen were made central to their army. Archers were an important contributor to the English victory at Poitiers, first firing upon the French cavalry head-on and then, when the knights’ armour proved too tough to penetrate, moving to one side and felling the horses with an attach on their flanks. The successful implementation here lay first in the English recognition of the power of the longbow and second in ensuring that the archers were effectively deployed in practice. The French also had archers and knew their power: they had suffered under the fire of English longbows in the Battle of Crécy ten years earlier. But they failed to integrate the archers into their fighting force as the English did, a failure that Barbara Tuchman ascribes to established social and cultural norms on the part of the French nobles: the French archers “were never properly combined in action with knights and men-at-arms, because French chivalry scorned to share its dominance of the field with commoners.” (153) In the English side this attitude was less dominant and they were able to benefit from the ranged power of the longbow.

A second factor played out in the tactics adopted by the French during the battle. The English force was very short of water and had dug in on a hill. Marshal Clermont, an experienced general and one of the senior French nobles present, proposed blockading the English and starving them out. Edward feared that the French would try this and the approach would likely have had an excellent chance of success. However, King Jean opposed the idea because it was at odds with the rules of chivalry. He chose instead to engage with the English and Clermont was among those killed in the fighting that followed.

Third, Edward had been able to organise his forces in a new way with some semblance of what we might recognise as a military hierarchy, with soldiers answerable to officers and officers to more senior commanders (this is not strictly true but captures the general idea). The French had no such structure and their commanders were at risk, as was often the case in medieval armies, from the fact that individual nobles and their followers might decide at any point that they had had enough and make a unilateral decision to leave the field of battle. With no notion of military discipline and troops’ loyalty in the first instance to their feudal overlord, the turning tide of the battle eventually led to a rout with surviving French nobles and foot soldiers fleeing before the rampaging English.

These were not the only things that contributed to the French defeat but they were important. The French lost, in part, because: their prevailing culture did not permit the effective implementation of a new technology (longbows); sociocultural factors prevented them from acting in a tactically beneficial way in reaction to the course of the battle; and they were tied to a harmful and outmoded organisational structure.

If we turn to contemporary writing on facilitators and barriers to implementation we find similar barriers to implementation recognised. Implementation science has been described as a discipline that focuses, in part, on “the discovery and identification of social, organizational, and cultural factors affecting the uptake of evidence-based practices and policies” (Luke 2012). The “evidence” available in the fourteenth century was not the type of evidence we might want to inform policy decisions today but it seems clear that social, organisational and cultural factors were key aspects of the French failure to implement new ways of thinking and acting that became major contributors to a French military disaster. Then, as now, social, organisational and cultural factors are central elements of what we have to recognise, consider, and address when considering implementing new practices or ways of doing things.

Plus ça change, plus c’est la même chose…

REFERENCES

My understanding of this topic has been informed by Barbara Tuchman’s outstanding A Distant Mirror: The Calamitous 14th Century (Knopf, 1978).

Luke DA. Viewing Dissemination and Implementation Research through a Network Lens. In Brownson RC, Colditz GA, Proctor EK. Dissemination and Implementation Research in Health: Translating Science to Practice. (Oxford: OUP)